What is next in prehospital telemedicine?

BRADLEY DEAN NREMT-P
04/26/2010 -

What do roadside recovery and home delivered groceries have in common? They are both inspiring new approaches to prehospital care. The culture within the prehospital realm has been to treat and transport, but it is time we begin to move towards treating and discharging. This will eventually reduce healthcare costs by reducing transports and overcrowding at facilities, for what may be a minor condition. The idea of bringing the physician to the patient instead of taking the patient to the physician is nothing new. This just brings a new meaning to home visits.

If you examine roadside service, the idea is to get the customer back on the road as soon as possible for a reasonable price. This avoids a towing bill, a delay at a service station and hours of frustration. The current estimate for roadside service is that approximately 80 percent are fixed on site. Most people’s “emergencies,” as prehospital providers well know, are not really emergencies. They are aches, pains, strains and other minor things that can often be treated by simple measures — like advice or prescriptions.

This realization fits conveniently with the burgeoning of telemedicine. Increasingly through the advancement of technology, patients can connect remotely to advisors, specialists and even their regular doctors for routine treatment of routine problems. Technological advances could establish from a 911 call that a situation is not emergent and redirect the caller to a toll-free number. This would still elicit a responding paramedic who would have the contact with a physician within 30 minutes. The paramedic, and the physician confer with the patient and consult their electronic health record; this proffers a diagnosis and course of treatment. Prescriptions can be called in, and the patient is spared travel to a clinic or hospital and languishing in a waiting room.

Making them go to a physician inconveniences people, but then again that is how they make their money. If a friend or family member calls a physician, do you think that they tell them that it is impossible for them to give them advice over the phone, that they would have to see them in the office? Of course not, they ask them pertinent questions and take care of their problem. The vision here is to move forward with this concept and provide the service that we would want our friends and loved ones to have. It is almost as good as having a doctor in the family.

The implications of services like this for EMS could be profound. First, we could prevent countless transports for trivial problems. Taking care of people at home and helping to manage patient demand can decompress the system. Secondly, and less obviously, the remote presence of physicians could mean greater latitude and importance for providers in the field.

Emergency Medical Services can be a tremendous wasted resource. Can you imagine right now, how many are transporting people for simple sprained ankles? Telemedicine pushed into the streets with the technology available can allow physicians to actually go into the field and take care of people with the assistance of paramedics and EMTs. With telemedicine we can go to where the people are, fix their problem, provide reassurance and get them back to a productive state. Telemedicine is a powerful tool for a system that is crashing.

Telemedicine is not a new technology. It has actually been around for years. The technology has not received much attention, until now. With the growing availability of broadband wireless systems, people across the country are taking notice of a technology that could change the entire face of EMS. One city with a lot of forward-thinking people is Tucson, AZ. They are running two pilot programs; one is a social service-type program, and the other is known as the ER Link program. The ER Link program places live streaming video in the back of ambulances that transfers to local hospitals and the regional trauma center attached to the University of Arizona. This entire program helps improve patient care by allowing the hospital to prepare for what they see with a trauma patient, as well as those that are non-urgent by allowing appropriate screening and disposition by paramedics in the field.

Another technology would allow a field medic to wear a set of glasses that contains a micro-camera that transmits through the EMS unit’s radio system to a remote location anywhere in the world, the physician on duty is allowed to view the patient. The paramedic’s glasses contain a micro screen that allows the paramedic to view an on screen display of questions from the physician without transmitting voice questions over the airwaves, follow-up orders can be administered and the paramedic documents the patient care electronically and returns to service. Imagine the number of transports that can be eliminated in both urban systems and rural systems with the long transport times if just one or two transport ambulances were converted to Quick Response Vehicles with one paramedic utilizing these off the shelf technologies.

While some of these technologies seem far from reality, much of the technology is already here with the video games that are on the market. We just have to adapt them for real purposes.

As we continue building on technology and expanding the scope of practice within the prehospital profession, who knows where the next round of telemedicine will take us.

Dean currently works as one of the Assistant Regional Emergency Response and Recovery Coordinators for the Triad Region of NC through Wake Forest University Baptist Medical Center Trauma Depart. He is a faculty member for the EMS Programs at Alamance Community College, and aa paramedic with Davidson County Emergency Services.